Thoracic Aortic Aneurysm (TAA)

A thoracic aortic aneurysm, also called TAA, is a bulging, weakened area in the wall of the aorta (the largest artery in the body), resulting in an abnormal widening or ballooning greater than 50 percent of the vessel's normal diameter (width).

The aorta extends upward from the top of the heart in the chest area then curves downward through the chest area into the abdomen.

An aneurysm can be characterized by its location, shape, and cause. A thoracic aortic aneurysm is located in the chest area. The thoracic aorta can be divided into segments: ascending aorta, aortic arch, and descending aorta, as described above. An aneurysm may be located in one of these areas and/or may be continuous throughout the aorta. An aneurysm called a thoracoabdominal aneurysm involves a thoracic aortic aneurysm extending down to the abdominal aorta. 

 

Thoracic aneurysms do not occur as often as abdominal aneurysms. The descending thoracic aorta is the most common location of a thoracic aneurysm, followed by the ascending segment, then the arch. The location of an aneurysm is distinctly connected with the cause, course, and treatment of a thoracic aneurysm. 

What are the different types of thoracic aortic aneurysms?

The shape of an aneurysm is described as being fusiform or saccular which helps to identify a true aneurysm. A true aneurysm involves all three layers of the arterial blood vessel wall. The more common fusiform-shaped aneurysm bulges or balloons out on all sides of the aorta. A saccular-shaped aneurysm bulges or balloons out only on one side.

There is a potential for rupture (bursting) or dissection (separation of the layers of the thoracic aortic wall), which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death.

Once formed, an aneurysm will gradually increase in size and there will be a progressive weakening of the aneurysm wall. Treatment for a thoracic aneurysm may include surgical repair or removal of the aneurysm to prevent rupture. 

What causes a thoracic aortic aneurysm to form?

Thoracic aortic aneurysms may be caused by different disease processes, especially in respect to their location. 

What are the symptoms of a thoracic aortic aneurysm?

Thoracic aortic aneurysms may be asymptomatic (without symptoms) or symptomatic (with symptoms). Symptoms of a thoracic aneurysm may be related to the location, size, and growth rate of the aneurysm.

Severe onset of pain associated with a thoracic aneurysm may be a sign of a life-threatening medical emergency.

Symptoms of a thoracic aneurysm may include, but are not limited to, the following:

  • Pain in the jaw, neck, and/or upper back
  • Pain in the chest and/or back
  • Wheezing, coughing, or shortness of breath as a result of pressure on the trachea (windpipe)
  • Hoarseness as a result of pressure on the vocal cords
  • Difficulty swallowing (dysphagia) due to pressure on the esophagus
How is a thoracic aortic aneurysm diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a thoracic aortic aneurysm may include any, or a combination, of the following:

  • Computed tomography scan (also called a CT or CAT scan).
  • Magnetic resonance imaging (MRI).
  • Echocardiogram (also called echo).
  • Transesophageal echocardiogram (TEE).
  • Chest X-ray.
  • Arteriogram (angiogram).
What is the treatment for thoracic aortic aneurysm?

Specific treatment will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your signs and symptoms
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

  • Controlling or modifying risk factors. Steps, such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm
  • Medication. Used to control factors such as hyperlipidemia (elevated levels of fats in the blood) and/or high blood pressure
  • Surgery
    • Thoracic aortic aneurysm open repair. The type of surgical repair of a thoracic aortic aneurysm will depend on several factors: the location of the aneurysm, the type of aneurysm, and the patient's tolerance for the procedure. For an ascending or aortic arch aneurysm, a large incision may be made through the breastbone (median sternotomy). If an ascending aneurysm involves damage to the aortic valve of the heart, the valve may be repaired or replaced during the procedure. For a descending aneurysm, a large incision may extend from the back under the shoulder blade around the side of the rib cage to just under the breast (thoracotomy). These approaches allow the surgeon to visualize the aorta directly to repair the aneurysm.
    • Endovascular aneurysm repair (TEVAR). TEVAR is a procedure which requires only small incisions in the groin, along with the use of X-ray guidance and specially-designed instruments, to repair the aneurysm by inserting a tube, called a stent-graft, inside the aorta. Not all thoracic aneurysms can be repaired by means of EVAR.

 

A small aneurysm or one that doesn't cause symptoms may not require surgical treatment until it reaches a certain size or is rapidly increasing in size over a short period of time. Your doctor may recommend "watchful waiting." This may include a CT scan or MRI scan every six months to closely monitor the aneurysm, and blood pressure medication may be used to control high blood pressure.

If the aneurysm is causing symptoms or is large, surgery may be recommended by your doctor.

The symptoms of a thoracic aortic aneurysm may resemble other conditions. Consult your doctor for a diagnosis. 

 
 


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